presentation to the saskatchewan special committee on...
TRANSCRIPT
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www.ccsa.ca • www.cclt.ca
Presentation to the Saskatchewan
Special Committee on Traffic Safety
Doug Beirness, Ph.D.
Saskatoon SK
June 3, 2013
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Overview
• Two Topics:
1. Alcohol-impaired driving
2. Drug-impaired driving
• Context
• Major issues within each
• Opportunities for change
• Evidence/rationale supporting change
• Recommendations/Suggestions
www.ccsa.ca • www.cclat.ca 2
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Overview
Alcohol-impaired Driving
Background/Context
What works?
High visibility enforcement
Administrative sanctions
Alcohol ignition interlocks
Assessment & rehabilitation
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www.ccsa.ca • www.cclat.ca 4
Overview
Drug-impaired Driving
Background/Context
Issues/Areas of Concern
Surveillance
Enforcement
Administrative sanctions
Assessment & rehabilitation
Prevention
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Context: Impaired Driving Laws
• Criminal Code of Canada • Driving while ability impaired by alcohol or drug
or a combination of alcohol and drugs
• Driving with a blood alcohol concentration (BAC)
over 80 mg/dL
• Refusing to comply with a demand for a sample of
breath, blood, urine or oral fluid or a demand to
participate in field sobriety tests or a drug
influence evaluation
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Context: SK Provincial Legislation
Over 80 mg/dL
• Immediate 24 hr suspension
• 90 day administrative suspension
Over 40 mg/dL
• Immediate 24 hr suspension
New Drivers over 0 mg/dL (zero tolerance)
• 30 day suspension
Fail or refuse SFST
• Immediate 24 hr suspension
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Magnitude of the Problem
From 2000 to 2010, 9175 people died in crashes on Canadian
roads involving a drinking driver
32,000 drinking drivers involved in serious injury crashes
Estimated $11 Billion in social costs per year
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Surveillance
Windows on the problem
www.ccsa.ca • www.cclat.ca 8
•Police charges
•Roadside surveys
•Crash-involved drivers
•Self-report surveys
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Self-reported Driving after Drinking
9
8.77.7 7.8 7.7
0
2
4
6
8
10
2008 2009 2010 2011
Source: Health Canada - CADUMS
2008 - 2011
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Roadside Surveys
• Wed through Sat
• 9:00 PM to 3 AM
• 4 sites per night – 90 minutes each
• Set up survey site in parking lot
• police officer to direct traffic
• Response rates are high!
Purpose: To collect objective information
on alcohol (and drug) use by
drivers
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Roadside Surveys:
Blood Alcohol Concentration
9.9
6.4
1.4 2.2
0
2
4
6
8
10
12
Alcohol Positive <50 50 - 80 >80
Perc
en
t
BAC mg/dL
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Number and Rate of Impaired Driving
Charges: Canada (2006 – 2011)
79225 82718 80045 77645 80339 78370
74331 79513
84759 88630
84397 90277
0
50
100
150
200
250
0
20000
40000
60000
80000
100000
Number
Source: Statistics Canada Catalogue 85-002-X
Rate
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Alcohol Use Among Fatally Injured Drivers (Canada: 2000 – 2010)
35.637.6 37.4
0
10
20
30
40
Percent SK=41.7%
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Drinking Driver Fatalities
According to Age
0
10
20
30
40
50
60
16 -19 20 -24 25-34 35- 44 45 -54 55-64 65-74 75 +
Age Group
Percent
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Alcohol Among Fatally Injured
Drivers: Canada 2000-2010
Tested Cases N=15,572
Alcohol
Negative
61.5% Alcohol
Positive
38.5%
BAC mg/dL
<50 11.5%
50-80 5.3%
80-160
26.8%
160+
56.4%
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Alcohol Among Fatally Injured Drivers:
Saskatchewan 2000-2010
Tested Cases N=932
Alcohol
Negative
56.2% Alcohol
Positive
43.8%
BAC mg/dL
<50 10.5% 3.9%
80-160
21.3%
160+
64.5%
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Countermeasures that Work
1. Administrative sanctions
2. Alcohol ignition interlocks
3. High profile intensive
enforcement
4. Assessment and rehabilitation
www.ccsa.ca • www.cclat.ca 17
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Administrative Sanctions
Already exist in SK
• Immediate 24 hr suspension for over 40 mg/dL
• Immediate 24 hr suspension followed by 90
suspension for BAC over 80 mg/dL
Is the room for improvement?
Can it be made more effective?
www.ccsa.ca • www.cclat.ca 18
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Administrative Sanctions
Canadian Council of Motor Transport Administrators (CCMTA) 2005 model for low BACs • Immediate 7-14 day suspension for over BAC over
50 mg/dL
• Confiscate licence and require a reinstatement fee
• More severe sanctions for repeat violations
• Ongoing public awareness and enforcement
Based on key components of deterrence –Swift, Certain, Severe
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BC’s Immediate Roadside Prohibition (IRP)
September 2010 BC Introducted New
Administrative Sanctions
Warn Range (50-80 mg/dL)
3 day license suspension
3 day impoundment
Administrative Penalty ($200)
Reinstatement fee ($250)
Towing and Storage ($150+)
Total = $600
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2010 Legislation – Immediate Roadside
Prohibition (IRP)
Fail Range (>80 mg/dL)
90 day license suspension
30 day impoundment
Administrative Penalty ($500)
Reinstatement fee ($250)
Towing and Storage ($680+)
Responsible Driver Program ($880)
Interlock ($1730)
Total = $4040
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Evaluation: Does it work?
Roadside Surveys
• June 2010 – prior to new IRP
• June 2012 – following new IRP
• Surveys dating back to 1995
Alcohol-involved Fatalities
• Before and after IRP
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Roadside Surveys:
Blood Alcohol Concentration
9.9
6.4
1.4 2.2
6.5
4.5
1.1 0.9
0
2
4
6
8
10
12
Alcohol Positive <50 50 - 80 >80
Perc
en
t
2010
2012
BAC mg/dL
59%
35%
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Roadside Surveys:
Percent of Drivers with BACs > 80 mg%*
2.0 2.0 1.9
2.9 2.7
2.4
0.6
0.0
0.5
1.0
1.5
2.0
2.5
3.0
1995 1998 2003 2006 2008 2010 2012
* Vancouver and Saanich only
75%
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Number of Alcohol-involved Fatalities:
October 2005 – September 2012
116 127
112
95
118
66 58
0
25
50
75
100
125
05/06 06/07 07/08 08/09 09/10 10/11 11/12
29.5%
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Alcohol Ignition Interlocks
1970:
Solution to the alcohol-crash
problem was a car that “Drunks
couldn’t drive”
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Breath test device linked to the vehicle’s ignition to prevent it from being started by someone who has had too much to drink
What is it?
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Do interlocks work?
1. Do interlock devices work? • Technical Standards for interlock devices
• Advanced technology prevents driver with BAC .01% over set point from driving 90% of the time
• Anti-circumvention features built into device
2. Are they effective? • Several studies all show reduced recidivism
among interlock participants relative to control groups
• Up to 90% fewer repeat offences among interlock participants
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Repeat Offenders Survival Rate
80
82
84
86
88
90
92
94
96
98
100
3 months 6 months 12 months 24 months
% n
ot
recid
ivati
ng
Interlock Period
3 months 6 months 12 months 24 months
After Interlock Period
Interlock
Suspended Interlock
Suspended
Ineligible
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Cochrane Review of Interlocks
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Centers for Disease Control Review
• “Strong evidence” that interlocks are effective in
reducing re-arrest rates
• Limited evidence that interlocks reduce alcohol-
related crashes
• Potential for interlocks to have significant impact
on impaired driving limited by the small
proportion of offenders who participate in
programs
• Link with rehabilitation
www.ccsa.ca • www.cclat.ca 31
Am J Preventive Medicine 2011;40(3); 362-76
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Interlocks in SK
• Voluntary program
• Offenders can reduce the period of
suspension by participating in interlock
program
• Approximately 500 interlock installations
per year
• Only 7% of offenders!!
• There is room for improvement
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Maximizing the Impact of Interlocks
Best Practices
• Perspective
• Purpose, rationale, guiding principles
• Form of incapacitation, not punishment
• Interlock is just a device. It cannot do more than
it was made to do.
• Interlocks are part of a comprehensive program
that includes education, rehabilitation, and
behaviour change
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Maximizing the Impact of Interlocks
• Mandatory participation for all convicted
offenders – including “first” offenders!
• Minimum installation of 12 months
• Behaviour-based criterion for removal –
make participants prove that they no
longer require the device before it is
removed
• Integrate interlock program with
rehabilitation program
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High Visibility Intensive Enforcement
• Police Checkpoints
• Purpose is deterrence
• Create real probability of detection
• Requires publicity
• Identify and charge violators
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High Visibility Intensive Enforcement
• Effectiveness
• US studies show up to 20% reduction in
fatal crashes associated with intensive
enforcement
• For every $1 invested in intensive
enforcement, $3.4 - $6 saved
• Publicity is a key element
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Screening, Assessment & Rehabilitation
• Alcohol abuse is a major contributing
factor
• Breaking the cycle is critical
• Evidence shows 8% benefit of
rehabilitation programs
• More comprehensive/inclusive programs
are better
• Need to review current system to
determine if it could be improved
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Recommendations
1. Strengthen administrative sanctions
2. Make interlock program mandatory for all
offenders
3. Integrate interlock program with rehabilitation
4. Enhance high visibility enforcement
5. Review current system of
screening/assessment and rehabilitation
6. Ensure all high BAC offenders complete
rehabilitation www.ccsa.ca • www.cclat.ca 38
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www.ccsa.ca • www.cclat.ca 40
Drug-impaired Driving
Background/Context
Issues/Areas of Concern
Surveillance
Policy and Legislation
Enforcement
• Training - DEC/SFST/ARIDE
Assessment & Rehabilitation
Prevention
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www.ccsa.ca • www.cclat.ca 41
Starting Points
Drug-impaired Driving
Related but different than alcohol
60+ years of research on alcohol
In retrospect, alcohol was “easy”
Drugs present a much more complex series
of problems
Extent of information pales in comparison
with that on alcohol
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What’s a Drug?
LSD
Illicit Drugs Pharmaceuticals
•LSD
•Crack
•Ecstasy
•Heroin
•Anti-
depressants
•Anti-
psychotics
Oxycodone Amphetamine
Ketamine
Dextromethorphan
Cannabis
Methamphetamine
Fentanyl
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What’s a Drug?
A “Drug” is any substance
which, when taken into the
human body, can impair the
ability of the person to operate a
vehicle safely.
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Surveillance
Windows on the problem
www.ccsa.ca • www.cclat.ca 44
•Police charges
•Roadside surveys
•Crash-involved drivers
•Self-report surveys
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Self-report Data
45 Source: Health Canada - CADUMS
2008 - 2011
8.79.0
7.87.7
2.82.4
2.6
2.2
0
1
2
3
4
5
6
7
8
9
10
2008 2009 2010 2011
Drive After Drinking
Drive After Cannabis
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Driving After Drinking and Driving After
Driving after Alcohol or Cannabis
According to Age
10.7
9.6
7.9
9.7
6.3
12.6
4.0
1.6 1.5 1.4
0
2
4
6
8
10
12
14
15-24 25-34 35-44 45-54 55-64
Drive after Drinking
Drive after Cannabis
Source:
Health Canada - CADUMS 2011
Age
Percent
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www.ccsa.ca • www.cclat.ca
Roadside Surveys
• BC 2008, 2010, 2012
• Collected oral fluid samples as
well as breath
• > 70% of drivers provide a
sample
• Sent to a lab for analysis
• Tested for:
– Cannabis
– Cocaine
– Opiates
– Amphetamine
– Benzodiazepines 47
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www.ccsa.ca • www.cclat.ca
Roadside Surveys
• Drug Positive = 8.1%
Cannabis
Cocaine
Opiates
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Fatally Injured Drivers
• Substances classified into 7 categories used by the Drug Evaluation and Classification program CNS Depressants (e.g., benzodiazepines) Inhalants (e.g., toluene, nitrous oxide) Dissociative Anaesthetics (e.g., ketamine, PCP) Cannabis CNS Stimulants (e.g., cocaine, amphetamines) Hallucinogens (e.g., LSD, ecstasy) Narcotic Analgesics (e.g., codeine, oxycontin)
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Drug and Alcohol Use Among Fatally Injured Drivers
36.6
40.9
29.7
35.3
0
5
10
15
20
25
30
35
40
45
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Alcohol
Drugs
Percent
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Drug and Alcohol Positive Driver Fatalities According to Age
16.3
28.426.7
25.224.0
17.1
10.8
18.8
15.9 16.4
19.2 18.917.9
19.5
0
5
10
15
20
25
30
≤18 19 -24 25-34 35- 44 45 -54 55-64 65+
Alcohol Only
Drugs Only
51
Percent
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Driver Fatalities Positive for Drugs or Alcohol According to Day of Week
17.115.3
16.518.7
23.0
33.7
28.9
20.923.2
21.1
17.9 17.5
13.314.9
0
5
10
15
20
25
30
35
Mon Tue Wed Thu Fri Sat Sun
Alcohol
Drugs
52
Percent
Day of Week
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Percent of Driver Fatalities Positive for Drugs or Alcohol Positive According to Time of Crash
13.1
6.58.9
13.7
27.0
33.9
40.043.8
23.426.4
23.4 21.7
15.812.4
9.6 10.4
0
10
20
30
40
50
6-9 9-12 12-15 15-18 18-21 21-00 00-3 3-6
Alcohol
Drugs
53
Percent
Crash Time
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Drugs Among Fatally Injured Drivers:
Canada 2000-2010
Tested Cases N=9,547
Drug
Negative
66.3% Drug
Positive
33.7%
Drug Type
Stim 6.3%
Dep 17.7%
Cannabis
36.9%
Polydrug
34.3%
Opiates 3.5%
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Drug Use According to Age Group
0
10
20
30
40
50
60
70
80
16-19 20-24 25-34 35-44 45-54 55-64 64-75 75+
Depressant
Cannabis
Stimulant
Narcotic
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www.ccsa.ca • www.cclat.ca 56
Key Action Areas
1. Legislation/Policy
What is it we’re trying to control?
Administrative Sanctions
2. Surveillance
Understand the magnitude and nature of the problem
3. Enforcement
Drug Evaluation and Classification Program
4. Prevention
Target groups
Focus
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Policy and Legislation
• Keep focus on road safety, not drug control
• Criminal Code Amendments 2008 gave police the powers and tools necessary to enforce drug-impaired driving
• Provincial sanctions lag behind, creating disparity
• Administrative suspensions
• SK provides 24 hr suspension for failing SFST
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Surveillance
• Need to know more about the nature and
magnitude of the problem
• Monitor drug use among drivers involved in
crashes
– Coroner data
– Hospital data
– Police data
• Roadside survey
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Enforcement
• 2008 Legislation provided police with
authority to demand a driver submit to:
Standardized Field Sobriety Test
(SFST)
Drug Influence Evaluation by a Drug
Recognition Expert (DRE)
SK has 27 active DREs
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SFST
• Horizontal Gaze Nystagmus
• One-leg Stand
• Walk-and-Turn
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Drug Evaluation and Classification (DEC)
• Systematic and standardized assessment of drug influence
• 12-step process assessing both clinical and psychophysical indicators of drug influence
• Purpose is to determine impairment and the drug category responsible for the impairment
• Concludes with the demand for a sample of bodily fluid for analysis of drug content to confirm officer’s opinion
• 2-week training course plus certification as a Drug Recognition Expert (DRE)
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DEC Program – Issues for Action
Training – lengthy, expensive, demanding
Training will become responsibility of provinces
Need to take steps to ensure strong, sustainable
program with a core of DREs and instructors
Enhance training for patrol officers in the
detection of signs and symptoms of drug use
that can form the basis of “suspicion” and
“reasonable and probable grounds” of drug
impairment
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Assessment and Rehabilitation
• Screening and Assessment
– Specific to different patterns of drug use
• Driving Without Impairment course
– 16 hours, $150
– Focus on alcohol
• Treatment/Rehabilitation
– Brief interventions
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Prevention
• Not simply a matter of changing
“Don’t Drink and Drive”
messages to include drugs
• Specific, targeted messages
Youth
Seniors
Health care providers
Those who mix drugs and
alcohol
• Opportunities abound
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Suggestions
1. Administrative sanctions
2. Create structure for a strong DRE
program
3. Review Assessment/Treatment and
ensure programs for drug-impaired
drivers
4. Facilitate Prevention activities
5. Roadside Survey
www.ccsa.ca • www.cclat.ca 65